Modified Mondays: Hyolaryngeal movement and an apology to an SLP in White Plains, NY

A few months ago, an SLP emailed looking for some information and video examples of hyolaryngeal elevation. I had planned to share this with that SLP directly…. and then I inadvertently deleted the email contact and cleaned out my deleted emails without realizing it. (That’s what I get for trying to get better about email inbox cleanliness, oof.) I felt pretty terrible about never responding, but I did remember that the SLP was from NY, so I am hoping this information will be found (as well as my sincere apology).

Anyway, the discussion we had centered around the labelling of laryngeal elevation as “incomplete” without the ability to measure or have standards to then compare the measurements to. We know there is a wide range of normal with regard to duration and extent of hyolaryngeal movement, so how do we decide what is “incomplete”? This video clip is a great example of how looking at hyolaryngeal movement as “impaired” might be a better description.

Hyolaryngeal movement contributes to closure of the laryngeal vestibule, movement of the epiglottis, and opening of the UES to allow for bolus passage. In this patient, we can see that none of these things are happening-the laryngeal vestibule remains open, there is little epiglottic movement, and most of the bolus remains in the pharynx and doesn’t pass through the UES… so for this patient it is clear that the hyolaryngeal movement is incomplete, because of the evidence of the impairment.

Because of the range of normal hyolaryngeal movement, without these impairments present, we can’t define what complete or incomplete is-we have to look to the actual physiology and the consequences of the physiology. This is all GIVEN the visual evidence of a VFSS, so if we are trying to define hyolaryngeal movement completeness (or incompleteness if you’re a glass half empty person) on clinical assessment… well, we just can’t, since we cannot see the impairments (or lack thereof).

See below for some really good resources:

Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Videofluoroscopy - PubMed (nih.gov)

Anatomy and Physiology of Feeding and Swallowing – Normal and Abnormal (nih.gov)

Swallowing Difference vs. Swallowing Disorder: The Power of Perspective - Dysphagia Cafe

Laryngeal Palpation - Dysphagia Ramblings